Prognostic value of initial F.D.G. PET in esophageal cancer

Esophageal cancer outcome greatly depends on pathological stage. Our objectives were to assess prognosis based on the initial F.D.G. PET scan, focusing on correlation between overall survival and F.D.G. uptake in the primary, as well as the presence of F.D.G. positive lymph nodes or metastases. Fifty-two esophageal cancer patients undergoing F.D.G. PET as part of initial routine staging procedure before treatment were included. The maximum standardized uptake value (SUVmax) was determined in each primary lesion and the number of abnormalities including primary, lymph nodes or distant metastases was recorded. Correlation with overall survival was performed using the Kaplan-Meier method and Cox regression analysis was used to assess the prognostic value of PET parameters. Half of the patients were planned for initial curative surgery (52%). Using univariate survival analysis, either surgery, SUVmax superior than 9, two or more PET abnormalities, or the presence of F.D.G. positive nodes were significant overall survival prognostic predictors. After multivariate analysis, only SUVmax superior than 9 and F.D.G. positive lymph nodes were found as independent predictors of poor outcome. In this prospective study F.D.G. PET was found to provide prognostic information supporting a new indication for initial F.D.G. PET examination in esophageal cancer. (authors)